Photographs, Xrays and a short video is made of your problem. The orthodontist evaluates this and in about 1-2 weeks a detailed report will be sent to you explaining the problem and the proposed treatment.

The advantage of this approach is that you have time to familiarise yourself with the information that the orthodontist provides and then if you have questions you can email these to Dr Hugo.

Dr Hugo will provide you with a lot of information in the report, then it is easier for you to make informed decisions or ask relevant questions by email, Whatsapp or sms

At the "Apply New Braces" appointment you will be shown photographs of your teeth on a large screen & shown in detail what is expected of you with regard to cleaning & elastic wear

If you wish you can book case discussion with Dr Hugo before starting treatment for which a consultation fee will be charged (see fees page).

What type of braces are available and which is the best for me?

There are 4 main types of braces:

1. Metal Braces: The best, strongest and cheapest braces are made of metal, are silver in colour, and are placed on the outside of the teeth.

2. Tooth-coloured (White) Braces: These porcelain braces are also a good option, although they cost more (see Fees) and break a bit more easily. If these braces are placed in the upper jaw only and metal braces are placed in the lower jaw, the additional cost is less (see Fees).

3. Lingual (Hidden) Braces: These are placed behind the teeth and are the least visible. These are a good option in many cases but are much more expensive (see Fees). Lingual braces are only placed in the upper jaw, usually with tooth-coloured braces in the lower jaw (see fees).

4.Invisalign: Invisalign is often the best treatment option but it is about R35 000 more expensive. Invisalign aligners need to be worn 20-24 hours per day and because they are removable it is easier to clean your teeth properly, but motivation and self-discipline are necessary to wear them correctly

Why are tooth-coloured braces less expensive in the lower jaw compared to the upper jaw?

In the lower jaw, a maximum of 6 tooth-coloured braces are placed on the front teeth because braces on the back teeth in the lower jaw are most likely to break as they are subject to the highest forces. In the upper jaw, tooth-coloured braces are placed on a maximum of 10 teeth (4 incisors, 2 canines and 4 premolars).

What are Speed Braces and are they different to Quick and Fast Braces?

Speed, Quick & Fast Braces are simply cleverly named metal braces. These names lead people to believe that their treatment will be faster. We prefer Synergy and Empower braces.

What are self-ligating brackets?

These are brackets that have a built-in locking mechanism so that elastic or wire ties don’t need to be used to hold the wire.

We have not found them to be in any way superior and, since they are usually more bulky and the mechanisms often stick, we no longer use them in most cases.

We only use self-ligating brackets with the tooth-coloured braces option so that there are no clear elastic ties which can discolour.

What is Invisalign and how does it work?

Invisalign treatment involves a series of clear plastic covers which progressively align the teeth in mouths where the teeth are not very skew.

What is informed consent?

Informed consent is written aknowledgment that we have explained certain facts to you, for example:

There are alternative options to orthodontics, such as no treatment – you will not die from skew teeth.

There are risks involved with orthodontics such as root-resorption and damage to the tooth enamel if your oral hygiene is not perfect.

Please see our informedconsent form for a complete list. Download our informed consent on documents page.

Who signs the informed consent form?

In South Africa the age of medical consent is 12 years, so in our practice both the parent/guardian, and any child over the age of 12 would need to sign the informed consent form.

FAQ During Treatment

Is it sore to have braces put on?

It is a bit uncomfortable/irritating to have braces put on but not sore.

When is the best time for my parents/guardians to get a progress report?

If your parent/guardian has queries, they should come through to the discussion area with you after your appointment is complete so that they can get the most up to date information. The orthodontist cannot discuss any aspect of your treatment with you or your parent/guardian until he has finished the appointment.

Can I phone to ask about the treatment?

All questions must be by sms or email to the number/address supplied on your appointment card. Please allow the orthodontist some time to get the file and respond by sms or email. However, such information will not be as up to date as information obtained immediately after an adjustment.

When does the mouth get sore from braces?

Teeth can feel tender and quite sore the next morning & for a few days after the braces are put on.

Can my parents come into the surgery during my treatment?

No, your parents will wait at reception until the appointment is completed. They can come to the discussion area with you if there are specific questions they would like to ask.

What can one do to reduce tenderness or discomfort?

We recommend that you stimulate blood flow by rubbing your teeth or chewing sugar-free chewing gum in the first few hours after your braces are applied. This has a physiotherapeutic effect and reduces the discomfort that is commonly experienced for the first 4 - 7 days. When you rub your teeth they ‘jiggle’ a bit making blood flow better. This also washes away the waste chemicals which can build up and irritate nerve endings. Use your knife and fork to cut your food into very small pieces, then roll your food around your mouth to taste it before you swallow.

What food should I avoid now that I have braces?

Avoid carbohydrates (especially sweets, crisps, fruit juices and fizzy drinks) as much as possible because oral bacteria use carbohydrates to produce tooth-damaging acid.

Steer clear of drinks with a low PH (such as fruit juices), or rinse your mouth thoroughly with water after drinking them.

The very worst foods for braces are biltong, dried sausage and popcorn. Even grated biltong cannot be eaten because it creates bacteria-laden strings that wrap around braces and cannot be removed with brushing. Dried sausage creates a similar problem.

Popcorn husks frequently find their way under braces and then under the gum. They can then cause severe abscesses, which can lead to periodontal disease and even the loss of teeth.

How do I brush my teeth?

You will be shown an example of the correct style of toothbrush, an interdental brush, and a special kind of floss called Superfloss. You will also be shown how to use them after your braces are placed.

How do I wear my elastics?

You will be shown at each visit how you are expected to wear your elastics. A photograph will be taken and emailed to you to help you remember how to wear your elastics. Patients on full-time elastic wear are expected to wear their elastics even during eating (except elastics between the front teeth). Full-time elastics should only be removed during brushing and flossing.

Why do I need to wear elastics?

Elastics provide a light continuous force which is ideal for tooth movement. Compared to appliances such as headgear (which we do not use), elastics are very simple to use.

How long will the treatment last?

First stage treatment usually lasts 6 - 12 months and full treatment lasts about 15 - 24 months. The duration of the treatment is dependent on various factors as well as patient cooperation with elastics, non-breakage etc.

How often do I need to come for adjustments?

After each visit you will be given a card with the information you need to make your next appointment. Generally appointments are every 8 - 12 weeks but more frequently (2-3 weekly) if you have had PAOO or jaw surgery, or you have an impacted tooth which is being moved into position (4-6 weekly).

What do I do if I break my braces?

The following steps should be followed:

Try to move the broken brace or wire into a position where it bothers you less.

Book an appointment for a breakage repair.

If you need more immediate advice send an sms to Dr Hugo at 082 377 4409 or phone Claire at 083 253 7157.

What can I do to make the treatment go faster?

The best contribution you can make is to wear your elastics as instructed. It helps to be aware of what movement is required by the elastics so that you can be motivated to achieve it. Obviously you should also try your best not to break your braces.

Why do I have two different bites?

People with upper to lower jaw discrepancies often have a bite of comfort where their teeth fit best. The second bite they experience is one in which their lower jaw joint is correctly centered. If there is more than a 2mm difference between these bites, you definitely need orthodontics.

Which of these bites is the correct bite?

The bite where your lower jaw is as far back as it can go is the correct one. The teeth and/or jaws should be moved with braces and/or a jaw operation so that this is your only bite.

What is PAOO?

Periodontally Accelerated Osteogenic Orthodontics can be thought of as bone softening and augmentation. This is a rather expensive but excellent surgical procedure which, with good oral hygiene, dramatically speeds up treatment and ensures good bone support for the teeth. This is particularly useful in cases where patients have inadequate bone around their teeth.

Why do some patients need jaw surgery?

Orthodontics can usually only correct discrepancies in upper to lower tooth/jaw position of about 3 - 5mm. If the lower jaw is shorter than the upper jaw by more than about 5mm, a good occlusion and profile can only be achieved by shifting the jaw surgically.

Does jaw surgery give you a better profile?

If for example, your lower jaw is underdeveloped, you will notice that by holding it forward with your teeth edge to edge, your profile improves. Obviously surgery will only be advised if there is an under or over-development of the upper or lower jaw.

Will my wisdom teeth need to be removed?

If wisdom teeth do not have enough space to grow into a good position, we will recommend they are removed, ideally at about 16 years of age before the roots are fully formed. If one waits any longer, the removal of wisdom teeth becomes more complicated. Download article.

What is a TAD?

A TAD is a temporary, small titanium screw sometimes placed in the mouth to provide anchorage. Often this can replace a more uncomfortable appliance like a headgear in selected cases.

Why do some patients need cement blocks on their molar teeth or bite ramps on their front teeth?

These are to prevent the front teeth from getting damaged or breaking the opposing braces. Both types of bite-opening devices are uncomfortable but necessary.

You should stop smoking for three months before and after jaw or gum surgery.

What is a tongue thrust?

A tongue thrust is an abnormal swallowing action in which the tongue is pushed forward between the front teeth (protrusive tongue thrust) or sideways between the back teeth (lateral tongue thrust) causing the teeth to be separated and preventing a proper bite.

How do you correct a tongue thrust?

You should practice what we call CLICK-SWALLOW: In this exercise, prior to taking a sip of water to swallow, you click the tongue up onto the roof or the mouth to remind yourself where the tongue should press during a correct swallow - then taking a sip of water, swallow by pushing the tongue up and back.

By making the swallowing action a conscious one often enough, many people are able to learn to swallow correctly. Sipping about a third of a glass of water this way, morning, afternoon and night each day is recommended.

What is an Open Bite and what causes it?

Open Bites are either caused by a tongue thrusting swallow or a tongue thrust has developed as a consequence of a vertical growth pattern where the lower jaw has grown downwards too much, away from the upper jaws.

Why is it difficult to correct an Open Bite?

Open bite closure cannot be guaranteed to remain stable even with jaw surgery, because learning a correct swallow is difficult, as swallowing is a subconscious activity. Because most people swallow about 2400 times per day the tongue is a dominant factor in the position of the teeth.

What is GERD?

If you are a mouth-breather, we would suspect GERD which is acid reflux from the stomach usually at night. This acid irritates the mucosa of the nasopharynx and makes you hold your tongue more forward, away from the irritated, inflamed throat thereby encouraging a tongue-thrusting swallow and also a habitually forward tongue posture, where the tongue is inserted between the front teeth.

Most people believe that GERD always is obvious because it causes heart-burn, but in 80% of sufferers, GERD is silent, so you are unaware of it, but your throat will appear inflamed, even if you do not have a sore throat, and you would most likely be prone to sinusitis or other chronic upper respiratory afflictions such a post-nasal drip.

One way of countering GERD is to take medication such as Nexium, but we would recommend you try a carbohydrate-free diet first or at least eliminate carbohydrates entirely after midday or lunch at the latest.

How can orthodontics help an open bite?

By moving the teeth together, orthodontics may help the patient to learn a correct swallowing pattern. During orthodontic treatment little spikes are make behind the teeth, which serve as reminders for the tongue not to press against the teeth when swallowing.

Why is it a problem to breathe through your mouth instead of your nose?

There are a number of problems with habitual mouth-breathing (see below) but the problems relating directly to teeth are as follows:

Teeth lie in what is called the NEUTRAL ZONE where the average pressure from the tongue and lips are equal. Often patients with open bites have their lips apart and this contributes to relapse, since the teeth are pushed forward and apart.

As soon as the lips part, the tongue drops down from the palate. The tongue in fact forms and supports the shape of the palate but in mouth-breathers the tongue isn’t supporting the palate so the cheek muscles push the back teeth inwards, creating a narrow upper arch and high palate.

Mouth breathers tip their heads backwards, to maintain an open airway and this is thought to contribute to the development of the malocclusions associated with the Long Face Syndrome and Adenoidal Facies appearance.

An essential exercise for mouth breathers is called LIP-PEN where for an hour a day, while watching TV or reading you hold a pen (sideways) between your lips to ensure nose-breathing and strengthen the lip muscles.

What other reasons are there to breath through your nose?

It is healthier to breath through the nose for the following reasons (see more at www.breathingretrainingcenter.com):

The chest wall expands and contracts in nose breathing, developing the chest better than with shallow mouth-breathing, where only the diaphragm moves.

When exhaling through the resistance of the nose the inhaled oxygen is forced into the blood under a favourable positive pressure gradient.

When inhaling against the resistance of the nose, the carbon dioxide is sucked out of the blood into the lungs under a favourable negative pressure gradient.

The nose warms the incoming air to 95 degrees Fahrenheit, which is the optimal temperature for the lungs.

Nose breathing moisturizes the incoming air. The average person breathes 20,000 times a day and by breathing through the nose, you add one liter of water to your internal environment.

The hairs and membranes of the nose filter the air during inhalation and help to secrete mucous, preventing coughing and throat clearing.

The movement of air through the nose keeps the environment around the inner auditory tubes free from stagnating debris.

Nose breathing triggers the release of anti-bacterial molecules helping to clean the incoming air and increase the functioning of the immune system.

Nose breathing activates the production of immunoglobulins to strengthen the immune system.

Breathing through your mouth causes the tissues in your nose and other airways to swell and become congested and thus make it more difficult to breathe.

Why do some people’s gums swell during orthodontics?

Poor or even imperfect brushing and flossing causes a build-up of plaque, which contains acids and germs which irritate the gums causing them to swell and bleed more easily.

What can be done about swollen and bleeding gums?

We recommend rinsing the mouth morning and evening with a warm salt water solution (1 teaspoon of salt in a glass of warm water). It is also imperative to brush meticulously and use the super-floss as recommended to you.

When do the gums need to be trimmed back with laser treatment?

When the patient has mastered excellent hygiene and the gums remain swollen we will book a 40 minute morning appointment at which time a little local anaesthetic is given before we trim away the swollen gum with small laser machine.

When can I have my braces removed?

When the orthodontist is happy that the best possible result has been achieved, he will advise you to schedule a morning appointment for the removal of the braces. Either the same day or within a few days after your braces have been removed you can collect your retainers.

Can my braces be removed before my orthodontics is complete?

Braces are removed prematurely in the following circumstances:

If oral hygiene is so poor that the teeth are at risk.

If the account is in arrears. Braces will be removed with the understanding that they will be replaced once the financial position of the patient/parent has improved and the account is up to date.

On the written request of a patient (and parent in the case of a minor child). A morning appointment will need to be scheduled to remove the braces.

FAQ After Treatment

Will I need retainers?

All orthodontically-treated patients need retainers, which need to be worn as follows:

All the time (except during eating and brushing) for the first week.

Afternoons and nights for the 2nd week.

Thereafter, nights only for the first year.

After the first year, every 2nd night until the end of growth and until wisdom teeth have been removed.

Thereafter, retainers can be worn progressively less eg once a week, then every 2nd week. However, for the rest of your life, you should check your retainers regularly. If they feel a bit tight, it shows that your teeth are moving skew and you should wear your retainers as often as necessary until they no longer feel tight.

What is a fixed retainer or splint?

A fixed retainer is a piece of wire glued behind the teeth to hold them in position.

Why do only some people have their teeth splinted?

We only splint the teeth of patients whose lower front teeth were quite skew before treatment. Because this splint passes between the teeth, it makes brushing and flossing rather difficult. In fact, Superfloss has to be used and there is a risk of tooth decay and periodontal disease if this isn’t done properly. These disadvantages of splints mean that we only make use of them when necessary. We don’t often use upper splints, as they are prone to getting bitten off if there is the correct amount of vertical overlap between the upper and lower incisors.

How often do I have to come for check-up appointments during retention?

The following intervals are recommended:

After 2 - 8 weeks for the first post-treatment check and final records.

Then after another 6 months. At this visit new retainers are sometimes made if the gums were swollen when the first retainers were made.

Then after another 6 months.

Then after 12 months.

Thereafter only as necessary if new retainers are needed or if there is a problem.